Interactive Brokers LLC Account Application for Financial Advisor Clients For Individuals or Joint Account Holders U992438 This application form is for Interactive Brokers individual or joint account applicants whose account will be managed by an advisor and who live in the United States or places other than Europe or Canada. Do not use this application if your account will not be managed by an advisor. Do not use this application for a corporate, organization, partnership, trust or IRA account. Do not use this application if you reside in Canada or Europe. Please answer ALL required questions. Failure to answer a question or provide a document or signature will delay approval of your account. Please check to ensure that you have completed all of the below steps before you return your application to us: Instructions: Complete All Application Forms. Fill Out the Security Question and Answer Section (Page 6). Specify Advisor Fee Arrangement. Provide All Required Signatures. Signatures Are Requested On The Following Pages: Page 16 Page 19 Page 19 Page 22 Provide Instructions For Initial Deposit Of Funds And/Or Securities To Your Account. Include Required Proof Of Identity And Address For Each Account Holder. Proof of Identity for Account Holder Separate Document as Proof of Address for Account Holder Proof of Identity for Joint Account Holder (If Joint Account) Separate Document as Proof of Address for Joint Account Holder (If Joint Account) Return Completed Application Package, Along With Proof Of Identity And Address Documents For Each Account Holder, And A Check (If You Are Funding Your Account With A Check) To Your Advisor Or To Interactive Brokers. If Sending To Interactive Brokers Directly, Use Any Of The Following: Scan and Email Courier/Overnight Service (e.g., Fed Ex) newaccounts@interactivebrokers.com Interactive Brokers LLC Document Processing 209 South LaSalle Street, 10th Floor Chicago, IL 60604 (312) 542-6901 Fax (312) 984-1017 Mail (Please allow extra time for processing) Interactive Brokers LLC Document Processing P.O. Box A3770 Chicago, IL 60690-3770 Thank You for choosing Interactive Brokers. Page 1 / 40
I. Account and Applicant Information Name of Your Financial Advisor Name of Advisor's Firm (if any) Country of Legal Residence State/Province Account Type (check only one) Individual Joint (check one): Joint Tenants - Right of Survivorship (if one holder dies, interest passes to other holder) Community Property (for married couples in community property states - check state law) Tenants in Common (if one holder dies, his/her percentage interest passes to estate) For Tenants in Common only, please enter percentages: Holder 1: % Holder 2: % Page 2 / 40
Account Holder First Name Joint Account Holder (if applicable) First Name Last Name Last Name Middle Initial Suffix Middle Initial Suffix Home Street Address (no P.O. boxes or "in care of" addresses allowed) Home Street Address (if different from other account holder) City City State/Province State/Province Country Country Zip/Postal Code Zip/Postal Code Phone No. (with area code) Phone No. (with area code) Second Phone No. (optional) Second Phone No. (optional) Fax No. (with area code) Fax No. (with area code) E-Mail Address for Account Correspondence Mailing Address (if different from above). P.O. boxes are allowed. Street Address Page 3 / 40
City State/Province Country Zip/Postal Code Page 4 / 40
Account Holder Date of Birth (mm/dd/yyyy) Joint Account Holder (if applicable) Date of Birth (mm/dd/yyyy) Mother's Maiden Name Mother's Maiden Name Marital Status Number of Dependents Marital Status Number of Dependants Single 0 Single 0 Married 1 Married 1 Divorced 2 Divorced 2 Widowed 3 Widowed 3 4 4 5+ 5+ Country of Citizenship Country of Citizenship Are you a U.S. Permanent Resident (Green Card Holder)? Yes No Are you a U.S. Permanent Resident (Green Card Holder)? Yes No > If you are a U.S. citizen, a U.S. resident or have a U.S Social Security Number, you must provide a Social Security Number: If you are a U.S. citizen, a U.S. resident or have a U.S Social Security Number, you must provide a Social Security Number: If you are not a U.S. resident, please check which form of identification you will provide to Interactive Brokers (you must provide a copy of one of the following): Driver's License Alien Identification Card Passport National Identity Card If you are not a U.S. resident, please check which form of identification you will provide to Interactive Brokers (you must provide a copy of one of the following): Driver's License Alien Identification Card Passport National Identity Card Country of Issuance: Country of Issuance: Number: Number: Account Holder Employment Type (choose one) Employed by Another Self-Employed Retired Unemployed Student At Home Trader Joint Account Holder (if applicable) Employment Type (choose one) Employed by Another Self-Employed Retired Unemployed Student At Home Trader Page 5 / 40
Occupation Occupation Name of Employer Name of Employer Nature of Employer's Business/Activities Nature of Employer's Business/Activities Employer's Address Street Employer's Address Street City City State/Province State/Province Country Country Zip/Postal Code Zip/Postal Code Employer's Phone No. (with area code) Employer's Phone No. (with area code) Please pick a security question from each of the three lists below and provide the answers to those questions so that we may use it in the future for verification purposes: In what city or town was your first job? Who was your first grade teacher? What city were you born in? What is name of first boyfriend/girlfriend? What is the last name of your favorite politician? What is the middle name of your eldest child? What is the name of a school you attended? What is the name of the High School you graduated from? What is the name of your favorite sports team? What is the name of your hometown newspaper? What is the street name your work office is located on? What is the street number of the house you grew up in? What is your favorite cartoon character? Page 6 / 40
What is your favorite color? What is your favorite place to shop? What is your favorite vegetable? What is your grandmother's first name? What is your shoe size (use decimals, if necessary)? What is your wife's middle name? What was the first concert you attended? What was the model of your first car? What was the name of a best friend during childhood? What was the name of your first pet? What was your High School mascot? What was your childhood nickname? What was your father's occupation? Where did you go on your honeymoon? Where is your favorite vacation spot? Who was your childhood hero? In what city were you married? Answer: In what city or town was your first job? In what city were you married? What city were you born in? What is name of first boyfriend/girlfriend? What is the last name of your favorite politician? What is the middle name of your eldest child? What is the name of a school you attended? What is the name of the High School you graduated from? What is the name of your favorite sports team? What is the name of your hometown newspaper? What is the street name your work office is located on? What is the street number of the house you grew up in? What is your favorite cartoon character? What is your favorite color? What is your favorite place to shop? What is your favorite vegetable? What is your grandmother's first name? What is your shoe size (use decimals, if necessary)? What is your wife's middle name? What was the first concert you attended? What was the model of your first car? What was the name of a best friend during childhood? What was the name of your first pet? What was your High School mascot? What was your childhood nickname? What was your father's occupation? Page 7 / 40
Where did you go on your honeymoon? Where is your favorite vacation spot? Who was your childhood hero? Who was your first grade teacher? Answer: In what city or town was your first job? Who was your first grade teacher? What city were you born in? What is name of first boyfriend/girlfriend? What is the last name of your favorite politician? What is the middle name of your eldest child? What is the name of a school you attended? What is the name of the High School you graduated from? What is the name of your favorite sports team? What is the name of your hometown newspaper? What is the street name your work office is located on? What is the street number of the house you grew up in? What is your favorite cartoon character? What is your favorite color? What is your favorite place to shop? What is your favorite vegetable? What is your grandmother's first name? What is your shoe size (use decimals, if necessary)? What is your wife's middle name? What was the first concert you attended? What was the model of your first car? What was the name of a best friend during childhood? What was the name of your first pet? What was your High School mascot? What was your childhood nickname? What was your father's occupation? Where did you go on your honeymoon? Where is your favorite vacation spot? Who was your childhood hero? In what city were you married? Answer: Additional Sources of Income (If Joint account, enter combined sources of income) Source of Income Annual percentage from this source Description of this source Employment Income Page 8 / 40
Consulting Disability Inheritance Interest Other Real Estate Rental Severance Spouse Trading & Investments Unemployment Account Financial Background (answer for both account holders if this is a joint account) Investment Objectives and Intended Purpose of Trading (check all that apply) Preservation of Capital Income Growth Trading Profits Speculation Hedging Investment Experience (please fill in all blanks) Years Trading Experience Number of Trades Per Year Knowledge Level (check one for each product type) Stocks Extensive Good Limited Bonds Extensive Good Limited Options Extensive Good Limited Futures Extensive Good Limited Forex Extensive Good Limited Estimated Net Worth (in base currency) (exclude value of residence) Estimated Liquid Net Worth (in base currency) (exclude residence) Page 9 / 40
Annual Net Income (in base currency) List other sources of funds aside from employment (if any) (this is required information if you are unemployed) Total Assets Page 10 / 40
Regulatory Information Will this account be used to trade and/or invest on behalf of any other person(s) besides the named account holder? Yes No Will all funds in this account belong to the named account holder ONLY and NOT from any third-party individual or entity, in any capacity? Yes No Have you received authorization from your employer's compliance department to open this account with IB? IB may require proof of this authorization from your employer before processing your account. Yes No Are duplicate statements and confirmations required to be sent to your firm's compliance department? IB may require proof from your employer indicating whether or not duplicate statements and confirmation are required before processing your account. Yes No Are the account holders or any immediate family member who resides in the same household, registered as a broker-dealer or an employee, director or owner of a securities or commodities brokerage firm? Yes No If Yes: Person's Name: Relation to Account Holder(s): Are the account holders a member of an exchange or a regulatory or a self-regulatory organization, or an associated person, affiliated person or employee of an exchange member? Yes No Have the account holders ever been the subject of, or initiated, litigation, arbitration or any other type of dispute or settlement procedure with another broker or dealer? Yes No If yes, please provide details, including the disposition of the litigation, arbitration or procedure: Brokerage Firm Name: Brokerage Firm Address: Have the account holders ever been the subject of an investigation or proceeding by any commodities or securities exchange or regulatory authority or self-regulatory authority? Yes No If yes, please provide details, including the disposition of the investigation or proceeding: Brokerage Firm Phone No.: Are the account holders: i) a director; ii) a 10% shareholder; or iii) a policy-making officer of any publicly traded company? Yes No If yes, enter the stock symbol(s) of the company(ies), separated by commas: NOTE: If any account holders is employed by a brokerage firm, the compliance officer of that firm must authorize this account by sending an e-mail to Interactive Brokers Processing Department at newaccounts@interactivebrokers.com. Do the account holders control the trading in, or have a beneficial ownership interest in, any other IB accounts? Yes No If yes, enter the Usernames of these accounts, separated by commas: The compliance officer should note "Employee Account Authorization" in the subject heading of the e-mail. The e-mail must state the following: "Interactive Brokers is authorized to establish and maintain an account for [Fill in Customer name]. [Fill in Name of Brokerage Firm] agrees to accept copies of daily confirmations and monthly statements by e-mail to [Fill in E-mail Address]." Page 11 / 40
II. Account Configuration Choose a Base Currency for the Account: United States Dollar USD Australian Dollar AUD British Pound GBP Canadian Dollar CAD Euro EUR Hong Kong Dollar HKD Japanese Yen JPY Mexican Peso MXN Swedish Krona SEK New Zealand Dollar NZD Swiss Frank CHF Choose Cash or Margin Account Cash Must have enough cash in the account to cover the cost of the transaction plus commissions. No shorting of stock or futures day trading benefits (50% of regular margin requirement during the day on certain exchanges). Limited purchase and sale of options and trading is only allowed for products denominated in the base currency of the account. Cash from the sale of stocks, options and futures becomes available when the transaction settles (e.g. US stock - 3 days, German stocks- 2 days, US options- 1 day). Portfolio Margin Same as a Reg T margin account (see below) except that margin requirements generally will be lower in a portfolio margin account because margin requirements will be calculated based on a risk based calculation methodology. Customers must maintain account equity of $100,000 in order to utilize a portfolio margin account. Otherwise Reg T margin requirements will apply. Reg T Margin Borrowing to support equities trading, shorting of equities, full options trading, full futures/futures options trading, currency conversions, and securities/commodities trading in multiple currency denominations available. Margin requirements are computed real-time under a rules-based calculation methodology, with immediate position liquidation if the minimum maintenance margin requirement is not met. Purchase and sale proceeds are immediately recognized. Page 12 / 40
Account Trading Permissions Please check all the products that you may want to trade in your account. You and your advisor also will have the ability to add additional products after your account has been opened. Stocks Fixed Income Warrants Options Futures Futures Options Single Stock Futures Mutual Funds FOREX (Foreign Exchange) Global Australia Austria Belgium Canada France Germany Hong Kong Italy Japan Mexico Spain Sweden Switzerland The Netherlands United Kingdom United States United States (Algorithmic Execution Venue) Please note that SEC restrictions prevent U.S. legal residents from trading OPTIONS on stock and indexes in Non-U.S. countries. Single Stock Futures trading requires a Reg T or Portfolio Margin Account Type. Notice Regarding Anti-Money Laundering and Customer Identification Procedures: To help the U.S. government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person or entity who opens an account. We are required by law to ask you to provide your name, address, date of birth and other information about you, your organization or persons related to your organization that will allow us to identify you before we approve your account. We also will ask you to provide certain identifying documents, such as your driver's license or passport or your organization's articles of incorporation and may obtain credit and other consumer reports to assist us in verifying your identity and in determining whether you satisfy our account criteria. Unless you provide the requested information and documentation, we may not be able to open your account. By applying for an IB account, you agree to provide accurate and truthful information as requested by IB and you consent to IB's acquisition of credit and other consumer reports about you for the purposes described above. Bundled & Unbundled Pricing Structure We offer two pricing structures for stocks and ETFs (in the US and Canada), and futures (worldwide). Our bundled structure utilizes a single rate inclusive of all exchange, clearing, broker, and regulatory fees, whereas our unbundled structure adds a fixed broker fee (which varies by volume) to external exchange, clearing, and regulatory fees. The unbundled pricing structure is not available for stocks outside of the US and Canada. Customers trading large volumes, covered under a futures exchange member or incentive program, or those that add stock liquidity will generally do better with our unbundled pricing structure. For more information on stocks pricing structures, click here, and for futures, click here. Please choose a Stocks (ETFs) and Futures pricing structure below: U.S. and Canadian Stocks (ETFs) Pricing Designation: Bundled Unbundled Futures Pricing Designation: Page 13 / 40
Bundled Unbundled Page 14 / 40
III.a ADVISOR FEE ARRANGEMENT Choose one of the following advisor fee billing methods: No Fee No fees are charged by your advisor for managing your account. Direct Billing You advisor bills you directly for fees and you pay your advisor directly (IB does not deduct the fees from your account). Automatic Billing Interactive Brokers calculates Advisor Fees and deducts these fees from your client account automatically and sends them to your advisor as specified. Check all that apply and fill-in the required amounts: Annualized Percentage of Net Liquidation Value applied on a daily basis (enter annual percentage) % Annualized Flat Fee applied on a daily basis, apportioned by 252 days (enter annual amount) Percentage of Annual Positive P&L applied as of 12/31(enter annual percentage) % Percentage of Quarterly Positive P&L applied as of March, June, Sept., Dec. (enter quarterly percentage) % Per-Trade Unit Advisory Fee. If this method is chosen, you must complete the fee schedule below. Monthly/Quarterly Invoicing Your advisor calculates the Advisor Wrap Fees and removes the fees from your account up to a limit of per month/ or per quarter. III.b FEE PER TRADE UNIT Please acknowledge the change in fees charged by your advisor and send back to IB at the address above. Any asset class/currency for which a fee per trade unit is not specified will use the IB standard commission schedule as its default, in which case the advisor will not make any fee over and above the fee IB charges the advisor's client to execute and clear trades. A fee per trade unit may be entered as an absolute markup over and above IB's standard commission, as a % of IB's standard commission, or as an absolute amount (IB's standard commission will be subtracted from this amount). Absolute markup is entered in the currency of the asset class. The unit column indicates if the absolute markup gets applied to shares, contracts, or % of notional value and up to three decimal places may be entered. As an example, when you enter "1" Absolute Markup on the USD option line, and if one IB Smart option contract were executed, the client would be charged $2 ($1 is the standard IB commission, and $1 is specified as an absolute markup). The % markup is entered as a percentage without the decimal point. As an example, if you enter "100" percent markup on the EUR stock line, if IB charges 10 EUR for a trade the client will be charged a total of 20 EUR for the trade (10 EUR for IB with a 100% match). The absolute amount requires the input of a minimum for the trade, and then 1 to 3 fees (Fee#1, Fee#2, Fee#3) that are specified by volume breaks (Vol#1, Vol#2). The unit column indicates if the absolute markup gets applied to shares, contracts, or % of notional value and up to three decimal places may be entered. As an example, if you wanted to charge.4% for up to 500 shares,.3% for up to 1,000 shares, and.2% above 1,000 shares with a minimum of 10 GBP (minimums are always entered amounts) for GBP stocks, you would enter: Minimum Fee #1 Vol #1 Fee #2 Vol #2 Fee #3 10 0.1 500 0.3 1,000 0.2 IB standard UK fees of.1%, and stamp tax of.5% would be subtracted from the absolute fee specified above. Only 1 fee type (i.e. absolute markup, % markup, or absolute amount) may be entered for each asset class/currency. It should be noted that in no case may you enter more than 15 times IB's standard commission. Advisor Fee Cap IB caps the amount of advisor fees earned in any 360 day period to 25% of the client's average equity over this period, with additional cap limits at 30 day increments in-between (i.e. 7.2% over the last 30 days, 17.7% over the last 180 days). When any fee cap is exceeded for a client, the advisor will not receive any client fees until the fee cap is no longer exceeded. IB will continue to charge its standard commissions when the fee cap limit is exceeded. Please be aware that advisors are solely responsible for ensuring that the fees they charge are reasonable and in accordance with regulatory requirements. For a complete fee cap, visit http://www.interactivebrokers.com/en/accounts/advisors/ advisorwrapfees.php?ib_entity=llc. Page 15 / 40
* Pass through exchange and regulatory fees applies to Absolute Amount only. Signature of Account Holder Second Signature (required only for joint and other accounts where multiple signatures needed) Date Date Page 16 / 40
IV. AGREEMENTS AND ACKNOWLEDGEMENTS Interactive Brokers Customer Agreement The Interactive Brokers Customer Agreement governs the relationship between Customer and Interactive Brokers and sets forth the terms and conditions governing Customer's IB account. The Customer Agreement has been provided separately to Customer as part of a package of documents labeled: Interactive Brokers LLC Agreements and Disclosure Documents. Customer must read the IB Customer Agreement in its entirety. Below are certain essential terms of the Agreement that Customer must understand: 1. Customer is obligated to accept all executions that are consistent with the instructions contained in Customer's orders. 2. IB's systems are computer-based and any computer-based system may fail at one time or another, often by reason of forces beyond human control. IB is not liable for system or network failures, and Customers who require the highest level of reliability agree to maintain alternate trading facilities. 3. Customers are responsible for protecting the secrecy of their usernames and passwords, and they will be responsible for trades entered by third parties using their usernames and passwords. 4. In the event trades are confirmed by IB as executed, and they are later cancelled by an exchange, trading network or regulatory authority, the IB confirmed trade will also be deemed cancelled. 5. IB submits all orders for execution in the order in which it receives them, including all orders submitted by IB or its affiliates. 6. IB is not responsible for the execution of orders at limit prices if the order's transmission is delayed or is otherwise affected by data communication failure. 7. IB does not provide trading, investment or tax advice, and Customers shall not rely on statements by IB employees which purport to provide such advice. 8. IB does not make margin calls, and IB maintains the right to immediately close out positions, without notice or liability, in any account that does not have sufficient funds to meet the margin requirements imposed by IB or regulatory authorities. 9. IB customers are responsible to IB for the continued accuracy and updating of all information provided to IB. Commodity Futures Trading Commission Risk Disclosure Statement Interactive Brokers provides you the following disclosure document in the event that you and your advisor choose to trade futures or options on futures in your Interactive Brokers account. Please read and sign the following document. Risk Disclosure Statement for Futures and Options This brief statement does not disclose all of the risks and other significant aspects of trading in futures and options. In light of the risks, you should undertake such transactions only if you understand the nature of the contracts (and contractual relationships) into which you are entering and the extent of your exposure to risk. Trading in futures and options is not suitable for many members of the public. You should carefully consider whether trading is appropriate for you in light of your experience, objectives, financial resources and other relevant circumstances. Futures 1. Effect of "Leverage" or "Gearing" Transactions in futures carry a high degree of risk. The amount of initial margin is small relative to the value of the futures contract so that transactions are `leveraged' or `geared'. A relatively small market movement will have a proportionately larger impact on the funds you have deposited or will have to deposit: this may work against you as well as for you. You may sustain a total loss of initial margin funds and any additional funds deposited with the firm to maintain your position. If the market moves against your position or market levels are increased, you may be called upon to pay substantial additional funds on short notice to maintain your position. If you fail to comply with a request for additional funds within the time prescribed, your position may be liquidated at a loss and you will be liable for any resulting deficit. 2. Risk-reducing orders or strategies The placing of certain orders (e.g. `stop-loss' orders, where permitted under local law, or `stop-limit' orders) which are intended to limit losses to certain amount may not be effective because market conditions may make it impossible to execute such orders. Strategies using combinations of positions, such as `spread' and `straddle' positions may be as risky as taking simple `long' or `short' positions. Options 3. Variable degree of risk Transactions in options carry a high degree of risk. Purchasers and sellers of options should familiarize themselves with the type of option (i.e. put or call) which they contemplate trading and the associated risks. You should calculate the extent to which the value of the options must increase for your position to become profitable, taking into account the premium and all transaction costs. The purchaser of options may offset or exercise the options or allow the options to expire. The exercise of an option results either in a cash settlement or in the purchaser acquiring or delivering the underlying interest. If the option is on a future, the purchaser will acquire a futures position with associated liabilities for margin (see the section on Futures above). If the purchased options expire worthless, you will suffer a total loss of your investment which will consist of the option premium plus transaction costs. If you are contemplating purchasing deepout-of-the-money options, you should be aware that the chance of such options becoming profitable ordinarily is remote. Selling (`writing' or `granting') an option generally entails considerably greater risk than purchasing options. Although the premium received Page 17 / 40
by the seller is fixed, the seller may sustain a loss well in excess of that amount. The seller will be liable for additional margin to maintain the position if the market moves unfavorably. The seller will also be exposed to the risk of the purchaser exercising the option and the seller will be obligated to either settle the option in cash or to acquire or deliver the underlying interest. If the option is on a future, the seller will acquire a position in a future with associated liabilities for margin (see the section on Futures above). If the option is `covered' by the seller holding a corresponding position in the underlying interest or a future or another option, the risk may be reduced. If the option is not covered, the risk of loss can be unlimited. Certain exchanges in some jurisdictions permit deferred payment of the option premium, exposing the purchaser to liability for margin payments not exceeding the amount of the premium. The purchaser is still subject to the risk of losing the premium and transaction costs. When the option is exercised expires, the purchaser is responsible for any unpaid premium outstanding at that time. Additional risks common to futures and options. 4. Terms and conditions of contracts You should ask the firm with which you deal about the terms and conditions of the specific futures or options which you are trading and associated obligations (e.g. the circumstances under which you may become obligated to make or take delivery of the underlying interest of a futures contract and, in respect of options, expiration dates and restrictions on the time for exercise). Under certain circumstances the specifications of outstanding contracts (including the exercise price of an option) may be modified by the exchange or clearing house to reflect changes in the underlying interest. 5. Suspension or restriction of trading and pricing relationships Market conditions (e.g. illiquidity) and/or the operation of the rules of certain markets (e.g. the suspension of trading in any contract or contract month because of price limits or "circuit breakers") may increase the risk of loss by making it difficult or impossible to effect transactions or liquidate/offset positions. If you have sold options, this may increase the risk of loss. Further, normal pricing relationships between the underlying interest and the future, and the underlying interest and the option may not exist. This can occur when, for example, the futures contract underlying the option is subject to price limits while the option is not. The absence of an underlying reference price may make it difficult to judge "fair" value. 6. Deposited cash and property You should familiarize yourself with the protections accorded money or other property you deposit for domestic and foreign transactions, particularly in the event of a firm insolvency or bankruptcy. The extent to which you may recover your money or property may be governed by specific legislation or local rules. In some jurisdictions, property which had been specifically identifiable as your own will be pro-rated in the same manner as cash for purposes or distribution in the event of a shortfall. 7. Commission and other charges Before you begin to trade, you should obtain a clear explanation of all commission, fees and other charges for which you will be liable. These charges will affect your net profit (if any) or increase your loss. 8. Transactions in other jurisdictions Transactions on markets in other jurisdictions, including markets formally linked to a domestic market, may expose you to additional risk. Such markets may be subject to regulation which may offer different or diminished investor protection. Before you trade you should inquire about any rules relevant to your particular transactions. Your local regulatory authority will be unable to compel the enforcement of the rules of regulatory authorities or markets in other jurisdictions where your transactions have been effected. You should ask the firm with which you deal for details about the types of redress available in both your home jurisdiction and other relevant jurisdictions before you start to trade. 9. Currency risks The profit or loss in transactions in foreign currency-denominated contracts (whether they are traded in your own or another jurisdiction) will be affected by fluctuations in currency rates where there is a need to convert from the currency denomination of the contract to another currency. 10. Trading facilities Most open-outcry and electronic trading facilities are supported by computer-based component systems for the order-routing, execution, matching, registration or clearing of trades. As with all facilities and systems, they are vulnerable to temporary disruption or failure. Your ability to recover certain losses may be subject to limits on liability imposed by the system provider, the market, the clearing house and/or member firms. Such limits may vary: you should ask the firm with which you deal for details in this respect. 11. Electronic trading Trading on an electronic trading system may differ not only from trading in an open-outcry market but also from trading on other electronic trading systems. If you undertake transactions on an electronic trading system, you will be exposed to risks associated with the system including the failure of hardware and software. The result of any system failure may be that your order is either not executed according to your instructions or is not executed at all. 12. Off-exchange transactions In some jurisdictions, and only then in restricted circumstances, firms are permitted to effect off-exchange transactions. The firm with which you deal may be acting as your counterparty to the transaction. It may be difficult or impossible to liquidate an existing position, to assess the value, to determine a fair price or to assess the exposure to risk. For these reasons, these transactions may involve increased risks. Off-exchange transactions may be less regulated or subject to a separate regulatory regime. Before you undertake such transactions, you should familiarize yourself with applicable rules and attendant risks. I hereby acknowledge that I have received and understood this risk disclosure statement: Page 18 / 40
Signature of Account Holder Signature of Joint Account Holder Date Date Futures Trading Arbitration Agreement If you trade stocks or stock options in your IB account, you will be covered by a mandatory arbitration agreement, which states that any disputes regarding your account will be resolved through arbitration. The following optional arbitration agreement covers trading in futures or options on futures, in the event that you and your advisor choose to trade these investment products in your account. You are not required to sign the Futures Trading Arbitration Agreement below, but if you do not sign it your account will be restricted to a one contract trading limit. Futures Trading Arbitration Agreement: Any controversy or claim between Interactive Brokers LLC ("IB") and the undersigned ("Customer") arising out of or relating to Customer's Account with IB, to transactions between IB and Customer, to the Customer Agreement with IB or any other agreement between IB and Customer, or to the breach of any such transaction or agreement shall, except as provided below, be resolved by arbitration before a forum chosen in accordance with the procedure set out below. If, by reason of any applicable statute, regulation, exchange rule or otherwise, Customer's advance agreement to submit a controversy to arbitration would not be enforceable by IB, this provision shall not permit Customer to enforce IB's advance agreement to submit to arbitration. Any award rendered in any arbitration conducted pursuant to this agreement shall be final, binding and enforceable in accordance with the laws of the State of Connecticut and judgment may be entered on any such award by any court having jurisdiction thereof. At such time as Customer notifies IB that Customer intends to submit a claim to arbitration, or at such time as IB notifies Customer that IB intends to submit a claim to arbitration, Customer will have the opportunity to choose a forum from a list of three or more qualified forums provided by IB. A "qualified forum" is an organization whose procedures for conducting arbitrations comply with the requirements of the Commodity Futures Trading Commission ("CFTC") Rule 166.5. As required by CFTC Rule 166.5, IB will pay any incremental fees which may be assessed by a qualified forum for provision of a mixed arbitration panel, unless the arbitrators hearing the controversy determine that Customer has acted in bad faith in initiating or conducting the arbitration. A "mixed arbitration panel" is an arbitration panel composed of one or more persons, a majority of whom are not members or associated with a member of a contract market or employee thereof, and who are not otherwise associated with a contract market. In connection with this Arbitration Agreement, IB is required to furnish to you the following statement, pursuant to Rule 166.5 of the CFTC: THREE FORUMS EXIST FOR THE RESOLUTION OF COMMODITY DISPUTES: CIVIL COURT LITIGATION, REPARATIONS AT THE COMMODITY FUTURES TRADING COMMISSION ("CFTC"), AND ARBITRATION CONDUCTED BY A SELF-REGULATORY OR OTHER PRIVATE ORGANIZATION. THE CFTC RECOGNIZES THAT THE OPPORTUNITY TO SETTLE DISPUTES BY ARBITRATION MAY IN SOME CASES PROVIDE MANY BENEFITS TO CUSTOMERS, INCLUDING THE ABILITY TO OBTAIN AN EXPEDITIOUS AND FINAL RESOLUTION OF DISPUTES WITHOUT INCURRING SUBSTANTIAL COSTS. THE CFTC REQUIRES, HOWEVER, THAT EACH CUSTOMER INDIVIDUALLY EXAMINE THE RELATIVE MERITS OF ARBITRATION AND THAT YOUR CONSENT TO THIS ARBITRATION AGREEMENT BE VOLUNTARY. BY SIGNING THIS AGREEMENT, YOU: (1) MAY BE WAIVING YOUR RIGHT TO SUE IN A COURT OF LAW; AND (2) ARE AGREEING TO BE BOUND BY ARBITRATION OF ANY CLAIMS OR COUNTERCLAIMS WHICH YOU OR IB MAY SUBMIT TO ARBITRATION UNDER THIS AGREEMENT. YOU ARE NOT, HOWEVER, WAIVING YOUR RIGHT TO ELECT INSTEAD TO PETITION THE CFTC TO INSTITUTE REPARATIONS PROCEEDINGS UNDER SECTION 14 OF THE COMMODITY EXCHANGE ACT WITH RESPECT TO ANY DISPUTE WHICH MAY BE ARBITRATED PURSUANT TO THIS AGREEMENT. IN THE EVENT A DISPUTE ARISES, YOU WILL BE NOTIFIED IF IB INTENDS TO SUBMIT THE DISPUTE TO ARBITRATION. IF YOU BELIEVE A VIOLATION OF THE COMMODITY EXCHANGE ACT IS INVOLVED AND IF YOU PREFER TO REQUEST A SECTION 14 "REPARATIONS" PROCEEDING BEFORE THE CFTC, YOU WILL HAVE 45 DAYS FROM THE DATE OF SUCH NOTICE IN WHICH TO MAKE THAT ELECTION. YOU NEED NOT SIGN THIS AGREEMENT TO OPEN OR MAINTAIN AN ACCOUNT WITH IB. SEE 17 CFR 166.5. I hereby acknowledge that I have read and understood and that I agree to the Futures Trading Arbitration Agreement: Signature of Account Holder Signature of Joint Account Holder Date Date Discretionary Trading Authorization/Power of Attorney for Financial Advisor and Request to Send Trade Confirmations and Account Statements to Advisor You are appointing a financial advisor ("Advisor"), chosen by you, to manage your Interactive Brokers account. The designated Advisor will be able to execute trades, deposit and withdraw money to and from your account (all withdrawals must be in your name), request information, receive account statements and confirmations, change certain of your customer information, and generally manage your Interactive Brokers account as specified below: General: Page 19 / 40
The terms and conditions of this Authorization are in addition to the provisions of all other agreements between Interactive Brokers and Customer or Advisor. The agreements applicable to Customer's account(s) will govern all orders and transactions, and Advisor is bound by all terms of those agreements. Request to Deduct Advisory Fees if Applicable: Customer requests and authorizes IB to deduct from Customer's IB account Advisory Fees and to disburse those Fees directly to the Advisor, based on the fee arrangement that Customer has agreed upon with the Advisor ("Fees") and specified to IB. If the Advisor bills Customer directly for Fees, or if Advisor does not charge Customer a Fee for Advisory services, Customer will specify that to IB. Request to Send Confirmations and Statements to Advisor: Customer requests that IB send all trade confirmations and account statements directly to Advisor and not to Customer directly. If Customer changes this instruction and decides that confirmations and account statements should be sent directly to Customer, Customer agrees to contact IB Customer Service at help@interactivebrokers.com or by calling the toll free Customer Service number listed on IB's website at www.interactivebrokers.com or www.interactivebrokers.co.uk or www.interactivebrokers.ca. Upon Customer's request, IB will provide Customer with a username and password so that Customer may view account statements online at the IB website. Advisor's Authority: This agreement authorizes Interactive Brokers to accept the instructions of the Advisor on behalf of the Customer. This authorization will be applicable to all assets Customer holds in all Interactive Brokers accounts for which Advisor has been designated. Customer hereby authorizes Advisor to inquire in, trade, buy, sell (including short sales), exchange, convert, tender, trade, or otherwise acquire or dispose of stocks, bonds, options securities, futures, security futures, foreign exchange and any other investments, on margin or otherwise, for and at the risk of the Customer. Customer understands that a commission will be charged to the account each time a trade is effected. The Advisor is also permitted to arrange for the deposit of funds and assets to the Customer's account(s) and to redeem or withdraw funds or assets from the Customer's account (including the delivery of securities from the account), for the benefit of the Customer, regardless of the tax consequences. The Advisor may initiate transfers (including inter-broker transfers), rollovers, Roth IRA conversions, IRA recharacterizations or other transfers of assets between and among Customer accounts. Customer authorizes Interactive Brokers, acting on Advisor's instructions, to aggregate transaction orders for Customer's account(s) with orders for one or more other accounts over which Advisor has trading authority. The Advisor is authorized to receive all information regarding the account(s) and to receive account statements, confirmations and tax information. The Advisor is authorized to add, delete or change Customer or account information. Interactive Brokers is authorized, but not required to, conduct further inquiry or seek authorization from the Customer or further clarification from Advisor or Customer regarding any instruction from Advisor for Customer's account(s). Interactive Brokers reserves the right, in it sole discretion, to refuse to honor particular instructions from Advisor, or to no longer honor instructions from Advisor. Customer and Advisor acknowledge that all information provided by either of them on this form, or otherwise provided to Interactive Brokers in the application process, is subject to verification, and Customer and Advisor authorize Interactive Brokers to verify all information through the use of credit agencies or any other customary or reasonable means. Advisor will provide promptly any information reasonably requested by Interactive Brokers concerning the management of the account(s) or compliance with this Authorization. This provision shall not be read to imply that Interactive Brokers has any duty to supervise or monitor Advisor's management of Customer's account(s) or compliance with applicable law. Not a Substitute for Advisory Agreement: Customer and Advisor acknowledge that this Authorization merely authorizes Advisor to conduct certain activities with respect to Customer's account and is not a substitute for an Advisory Agreement and is not designed to satisfy any regulatory obligations applicable to Advisor to enter such agreement. Role of Interactive Brokers - Disclaimer and Waiver of Liability: ADVISOR WAS SELECTED SOLELY BY CUSTOMER AND HAS NOT BEEN RECOMMENDED OR ENDORSED BY IB. ADVISOR IS NOT EMPLOYED BY OR REGISTERED OR ASSOCIATED WITH IB. IB WILL NOT INVESTIGATE OR JUDGE THE COMPETENCE OR INTEGRITY OF THE ADVISOR OR MONITOR THE ACTIONS OF THE ADVISOR. IB WILL NOT REVIEW THE ADVISOR'S RECOMMENDATIONS OR JUDGE THE SUITABILITY OF ANY TRADING OR INVESTMENT RECOMMENDATION OR DECISION OF ADVISOR OR CUSTOMER. IB DOES NOT PROVIDE ADVISORY SERVICES TO IB CUSTOMERS AND WILL NOT PROVIDE INVESTMENT OR TRADING OR TAX ADVICE REGARDING THE ACCOUNT. Advisor's Compliance with State, Federal or Non-U.S. Law: Advisor will comply with all applicable state and federal securities laws and regulations, including the Investment Advisors Act of 1940, the Commodity Exchange Act and comparable state laws, and will comply with any applicable laws of Non-U.S. jurisdictions (hereinafter "Applicable Laws and Regulations"). Interactive Brokers assumes no responsibility for determining if Advisor is complying with Applicable Laws and Regulations regarding its provision of advisory services. CUSTOMER ACKNOWLEDGES THAT IB IS NOT RESPONSIBLE FOR DETERMINING WHETHER ADVISOR IS REQUIRED TO BE REGISTERED OR LICENSED OR WHETHER ADVISOR IS EXEMPT FROM REGISTRATION OR LICENSING. THIS IS SOLELY THE RESPONSIBILITY OF ADVISOR. IF CUSTOMER HAS QUESTIONS ABOUT THIS, CUSTOMER MUST CONTACT ADVISOR FOR FURTHER INFORMATION. Termination: Customer and/or Advisor agree(s) to notify Interactive Brokers immediately, in writing, if Customer or Advisor terminates, modifies or revokes this Authorization. Advisor agrees to notify Interactive Brokers immediately, in writing, if Customer dies or becomes incapacitated such that this Authorization would be rendered void. This Authorization shall remain in effect until Interactive Brokers receives written notice of its termination and has had sufficient time to process such notice and terminate Advisor's authority. Indemnification of Interactive Brokers by Customer: Customer agrees to indemnify and hold Interactive Brokers, and its affiliates, and its and their successors and assigns, and its and their directors, officers, employees and Advisors harmless from and against all claims, actions, costs and liabilities, including attorney's fees, arising out of or relating to their reliance on this Authorization or their execution of any of Advisor's instructions. Customer agrees that since Interactive Brokers will not supervise or monitor Advisor's trading decisions or other activities, Customer will not attempt to hold Interactive Brokers liable for any trade or decision or action of Advisor. Interactive Brokers'srights under this paragraph are in addition to any other rights it has under other agreements with Customer and/or Advisor. Indemnification of Interactive Brokers by Advisor: Page 20 / 40
Advisor agrees to indemnify and hold Interactive Brokers, and its affiliates, and its and their successors and assigns, and its and their directors, officers, employees and Advisors harmless from and against all claims, actions, costs and liabilities, including attorney's fees, arising out of or relating to any breach by Advisor of any provision of this Agreement or other Agreements with Interactive Brokers and/or Customer; the performance or non-performance of the Advisor's services; any trade or action of Advisor in Customer's account(s); and any dispute involving Advisor and Customer. Interactive Brokers's rights under this paragraph are in addition to any other rights it has under other agreements with Customer and/or Advisor. Customer's Representations and Acknowledgments: A. Customer has granted to Advisor the full discretion to direct the trading in the account(s) on Customer's behalf and Customer will not have access to IB's electronic systems for placing orders for the account. Only the Advisor will be able to use the IB Trader Workstation to conduct trading in the account. B. If Customer terminates the relationship with Advisor or for any other reason wishes to terminate Advisor's access to the account(s), or if Customer wishes to direct the trading in Customer's account, or if Customer wishes to use advisory services of another Advisor, Customer will contact IB immediately by email to help@interactivebrokers.com or by calling the toll free Customer Service number listed on IB's website at www.interactivebrokers.com or www.interactivebrokers.co.uk or www.interactivebrokers.ca. C. Because Customer has instructed IB to send all confirmations and account statements directly to Advisor, Customer will rely on Advisor for information regarding Customer's account. If Customer has any questions or concerns regarding the account, Customer will contact IB Customer Service at help@interactivebrokers.com or by calling the toll free Customer Service number listed on IB's website at www.interactivebrokers.com or www.interactivebrokers.co.uk or www.interactivebrokers.ca. D. Depending on the equity in Customer's account, deduction of Advisory Fees in an IB margin account may cause the account to incur margin interest. Furthermore, if deduction of Advisory Fees would cause the account to have insufficient equity to cover margin requirements or to satisfy any other obligation to IB, IB may, at its sole discretion: (1) deduct the Fees and exercise any of its rights and remedies under the IB Customer Agreement, including liquidating positions in the account without prior notice in order to satisfy margin requirements or obligations; and/or (2) decline to deduct the Fees, in which case Customer will be liable to pay such Fees to Advisor directly. E. All claims, questions or disputes regarding IB's provision of brokerage services or regarding IB's execution of particular trades must be referred to IB. Advisor has no authority to resolve such claims or disputes on IB's behalf. F. ALL CLAIMS OR DISPUTES REGARDING ADVISOR's SERVICES OR ACTIONS (INCLUDING SPECIFIC CONDUCT, ADVICE, RECOMMENDATIONS, OR TRADES PLACED BY ADVISOR OR FEES OWED) ARE SOLELY BETWEEN CUSTOMER AND ADVISOR. IB IS NOT LIABLE FOR ANY SUCH CLAIMS AND DISPUTES AND CUSTOMER UNDERSTANDS AND FULLY ACKNOWLEDGES THAT CUSTOMER CANNOT BRING A CLAIM AGAINST IB OR RECEIVE DAMAGES OR COMPENSATION OF ANY KIND FROM IB, INCLUDING CLAIMS FOR DIRECT, INDIRECT, COMPENSATORY, INCIDENTAL, SPECIAL, EXEMPLARY, PUNITIVE OR CONSEQUENTIAL DAMAGES. ALL CLAIMS OR DISPUTES REGARDING THE FEES OWED TO ADVISOR ARE SOLELY BETWEEN CUSTOMER AND ADVISOR. IF CUSTOMER DISPUTES ADVISOR's RECEIPT OF ANY FEES THAT IB HAS DEDUCTED FROM THE ACCOUNT AND SENT TO ADVISOR, CUSTOMER UNDERSTANDS THAT CUSTOMER's SOLE REMEDY IS AGAINST ADVISOR AND CUSTOMER AGREES NOT TO BRING ANY CLAIM AGAINST IB. G. Arbitration: The agreements between Customer and Interactive Brokers (which are also binding on Advisor) contain mandatory arbitration clauses requiring all parties to arbitrate any disputes regarding securities trading. The agreements may also contain arbitration provisions regarding futures trading. All applicable arbitration clauses are incorporated herein by reference. Signature CUSTOMER REPRESENTS THAT CUSTOMER HAS RECEIVED THE PACKAGE OF DOCUMENTS TITLED "INTERACTIVE BROKERS LLC AGREEMENTS AND DISCLOSURE DOCUMENTS" AND HAS READ AND UNDERSTOOD AND INTENDS TO BE BOUND BY THE INTERACTIVE BROKERS CUSTOMER AGREEMENT AND ALL OF THE PROVIDED DISCLOSURE DOCUMENTS. CUSTOMER REPRESENTS THAT CUSTOMER HAS READ AND UNDERSTOOD AND INTENDS TO BE BOUND BY THE ABOVE "DISCRETIONARY TRADING AUTHORIZATION/ POWER OF ATTORNEY FOR FINANCIAL ADVISOR AND REQUEST TO SEND TRADE CONFIRMATIONS AND ACCOUNT STATEMENTS TO ADVISOR" CUSTOMER REPRESENTS THAT ALL INFORMATION PROVIDED DURING THE ACCOUNT APPLICATION PROCESS IS TRUE AND CORRECT AND AGREES TO NOTIFY INTERACTIVE BROKERS OF ANY MATERIAL CHANGES IN THAT INFORMATION. U.S. TAX CERTIFICATION: UNDER PENALTIES OF PERJURY, I CERTIFY THAT: 1) THE NUMBER PROVIDED IN THIS APPLICATION IS MY CORRECT TAXPAYER IDENTIFICATION NUMBER (OR I AM WAITING FOR A NUMBER TO BE ISSUED TO ME); AND 2) I AM NOT SUBJECT TO BACKUP WITHHOLDING BECAUSE: (A) I AM EXEMPT FROM BACKUP WITHHOLDING, OR (B) I HAVE NOT BEEN NOTIFIED BY THE INTERNAL REVENUE SERVICE (IRS) THAT I AM SUBJECT TO BACKUP WITHHOLDING AS A RESULT OF A FAILURE TO REPORT ALL INTEREST OR DIVIDENDS, OR (C)THE IRS HAS NOTIFIED ME THAT I AM NO LONGER SUBJECT TO BACKUP WITHHOLDING. ACCOUNT TRANSFER: IF CUSTOMER HAS PROVIDED INFORMATION REQUESTING THAT ANOTHER BROKER TRANSFER ASSETS AND/ OR CASH TO INTERACTIVE BROKERS, CUSTOMER HEREBY REQUESTS SUCH TRANSFER PURSUANT TO THE TERMS AND CONDITIONS SPECIFIED BELOW IN THE SECTION: "FUND YOUR ACCOUNT/TRANSFER FROM ANOTHER BROKER" THE INTERACTIVE BROKERS CUSTOMER AGREEMENT CONTAINS AN ARBITRATION CLAUSE REQUIRING BOTH PARTIES TO ARBITRATE ANY DISPUTES REGARDING SECURITIES TRADING OR CUSTOMER's SECURITIES ACCOUNT. CUSTOMER MUST BE AWARE THAT: ARBITRATION IS FINAL AND BINDING ON THE PARTIES. THE PARTIES ARE WAIVING THEIR RIGHT TO SEEK REMEDIES IN COURT, INCLUDING THE RIGHT TO JURY TRIAL. PRE-ARBITRATION DISCOVERY IS GENERALLY MORE LIMITED THAN AND DIFFERENT FROM COURT PROCEEDINGS. Page 21 / 40
THE ARBITRATORS'S AWARD IS NOT REQUIRED TO INCLUDE FACTUAL FINDINGS OR LEGAL REASONING AND ANY PARTY'S RIGHT TO APPEAL OR TO SEEK MODIFICATION OF RULINGS BY THE ARBITRATORS IS STRICTLY LIMITED. THE PANEL OF ARBITRATORS WILL TYPICALLY INCLUDE A MINORITY OF ARBITRATORS WHO WERE OR ARE AFFILIATED WITH THE SECURITIES INDUSTRY. Signature of Account Holder Signature of Joint Account Holder Date Date Page 22 / 40
V. INTERACTIVE BROKERS LIMITED LIABILITY AGREEMENT Agreement Limiting Interactive Brokers' Liability for Decisions and Actions of Your Independent Financial Advisor. Please review each of the statements below and then: 1) initial each statement if you agree, and then: 2) sign the agreement at the bottom In consideration for maintaining a brokerage account at Interactive Brokers, Customer agrees: 1. I understand that my financial advisor is independent from interactive brokers ("IB") and is not an employee or an agent of IB. I agree that Interactive Brokers is not liable for the trading decisions or actions of my advisor and I agree not to bring lawsuits or claims of any kind against IB for actions or trading decisions of my advisor. AGREED BY: INITIALS 2. I understand that Interactive Brokers' only role is to execute trades ordered by my advisor and hold my positions in an IB account. I agree that since IB does not recommend trades or give advice, IB will not conduct any "suitability" review to make sure that my advisor's trading decisions are suitable for my circumstances and objectives. AGREED BY: INITIALS 3. I selected my advisor personally. I understand that Interactive Brokers does not research or recommend particular financial advisors. I understand that IB has not recommended or investigated my advisor. AGREED BY: INITIALS 4. Since Interactive Brokers is not providing any advice to me, if my account generates profits, I will not have to share the profits with IB. Likewise I agree that if my account suffers losses, Interactive Brokers will not repay or be responsible for my losses. AGREED BY: INITIALS 5. I agree that Interactive Brokers does not see my advisor's communications to me and is not responsible for statements or information coming to me from my advisor. I agree to login to the IB website or to contact IB if I want to verify any account or profit/loss information given to me by my advisor. AGREED BY: Understood and Agreed: INITIALS Signature: Printed Name of Customer: Date: Page 23 / 40
VI. FUND YOUR ACCOUNT Select funding method: How do you wish to initially fund your account? (choose one) Check (Cashiers, Bank and Teller checks accepted. Checks are only accepted for U.S. dollar currency deposits. Personal checks are held for 10 business days before funds are available for trading.) Wire Transfer Free of Payment (FOP) Request Account Transfer from Another Broker - ACATS (ATON for Canadian Assets). Transfer of cash and securities positions from a thirdparty broker. Only transfers from a US or Canadian broker can be accepted (3 to 7 days for assets to arrive depending on the third-party broker). Please note, a number of brokers require a paper ACAT signature for transfer. If your broker is listed below, you must send a copy of the ACAT portion of your application directly to this broker. Firm Name Ameritrade Clearing National Financial Services Legent Brown and Co E*Trade Southwest Securities Computer Clearing Services Fahnstock Wachovia Securities, LLC Salomon Smith Barney Morgan Stanley Dean Witter Documents Requested Partial ACAT Partial and full ACATs Partial ACAT Partial ACAT Partial ACAT Partial ACAT Partial ACAT Partial ACAT Partial and full ACATs Partial and full ACATs Partial and full ACATs Complete only one of the below sections: Check: Complete this section only if you want to initially fund your account with a check: Amount of check (check must be in U.S dollars) Check Number (optional) Bank Routing (ABA) Number on check: Bank Account Number Instructions for Check Deposits: So that we may process your check as quickly as possible, please enter check information in the spaces provided above. If you are not sure what to enter, please see the example below: Please make your check payable to "Interactive Brokers LLC" and make sure the names of all account holders are written on the check (use the Memo line if necessary). Please enclose your check with this completed application. If you are faxing or e-mailing us your completed application and you want to mail the check separately, send it to: Interactive Brokers 8 Greenwich Office Park Greenwich, CT 06831-0504 Attn: IBCD Page 24 / 40
Free of Payment (FOP) Request: Complete this section only if you want to initially fund your account with a wire transfer: This form authorizes the transfer of assets held at a third-party broker to be moved to Interactive Brokers. You must contact your third-party broker to initiate the transfer. Your Account Name, Tax Identification Number, and Customer Type (i.e. individual, joint, Roth IRA) for your Interactive Brokers Account should match the third-party broker account in order for the transfer to take place. Please note that Interactive Brokers accepts only products that it makes available for trading. Certain products, such as Mutual Funds and Limited Partnership units cannot be held in your Interactive Brokers account. Please Note: You should confirm with your sending broker their DTC Participant # so as not to delay the processing of your Free of Payment delivery. Third-party Broker Account Name Account Number: Please specify stock positions to transfer: Symbol: Shares: Please specify bond positions to transfer: CUSIP Number (All Uppercase): Quantity: Please specify warants positions to transfer: Symbol: Shares: Exchange (optional): Page 25 / 40
Signature of Account Holder Date Page 26 / 40
Wire Transfer: Complete this section only if you want to initially fund your account with a wire transfer: Amount of wire transfer Currency of wire transfer (for example: U.S. dollars) Name of Sending Bank/Broker Instructions for Wire Transfer: You must notify your bank to send a wire. All incoming wires must have the account holder's name (both names if a joint account). Depending on your bank, please allow one to four business days for your funds to be received. For security reasons, incoming funds are held for ten business days before you can withdraw the funds. Use the chart below to determine where to have your bank send the wire transfer, based on the currency of the funds being sent. For wires originating in the same country as the receiving bank listed below, please instruct your bank to send funds via the in-country payment system(s). For wires originating outside the country of the receiving bank, instruct your bank to send funds via SWIFT. Line 59 of the SWIFT message should include Interactive Brokers LLC Bank Account Number at Citibank and Line 70 of the SWIFT message should include your name (IB Account Holder's Name). Currency Receiving Bank Name and Address Receiving Bank Codes Receiving Bank Account Name and Number If funds wired in U.S. Dollars: Citibank, N.A. (New York Branch) 111 Wall Street, 19th Floor New York, NY 10043 United States of America ABA Number: 021000089 SWIFT BIC Code: CITI US 33 Interactive Brokers LLC Bank Account No. 40806826 For further credit to: [Insert All Account Holder Name(s)] If funds wired in Australian Dollars: Bank of America, N.A. (Sydney Branch) Level 64, MLC Centre, 19 Martin Place, SYDNEY NSW AUSTRALIA 2000 BSB Code: 232-001 SWIFT BIC Code: BOFFAAUSX Interactive Brokers LLC Bank Account No. 15344028 For further credit to: [Insert All Account Holder Name(s)] Interactive Brokers LLC Bank Account No. 095911034289 If funds wired in Canadian Dollars: Royal Bank of Canada (RBC) 180 Wellington St. W. Toronto, ON M5J1J1 Canada SWIFT BIC Code: ROYCCAT2 Transit: 09591 Institution: 0003 Wire Beneficiary Address: Interactive Brokers, 1 Pickwick Plaza, Greenwich, CT, 06831 United States For further credit to: [Insert All Account Holder Name(s)] Interactive Brokers LLC Bank Account No. 10569674 If funds wired in Swiss Francs: Citibank, N.A. (London Branch) 336 Strand, London WC2R 1HB United Kingdom Sort Code: 185008 SWIFT BIC Code: CITI GB 2L Int'l Bank Acct No. (IBAN): 35CITI18500810569674 For further credit to: [Insert All Account Holder Name(s)] Interactive Brokers LLC Bank Account No. 08774544 If funds wired in British Pounds: Citibank, N.A. (London Branch) 336 Strand, London WC2R 1HB United Kingdom Sort Code: 185008 SWIFT BIC Code: CITI GB 2L Int'l Bank Acct No. (IBAN): GB13CITI18500812304430 For further credit to: [Insert All Account Holder Name(s)] If funds wired in Euros: Citigroup Global Markets Deutschland AG & Co. REUTERWEG 16 60323 FRANKFURT AM MAIN GERMANY FRANKFURT AM MAIN BLZ No.: 50210900 SWIFT BIC Code: CITI DE FF Interactive Brokers LLC Bank Account No. 0119754038 Int'l Bank Acct No. (IBAN): DE69502109000215520013 For further credit to: [Insert All Account Holder Name(s)] If funds wired in Hong Kong Dollars: Citibank, N.A. (Hong Kong Branch) 9/F Two Harbourfront 22 Tak Fung Street CHATS Code: 006/391 Interactive Brokers LLC Bank Account No. 17739993 Page 27 / 40
Hunghom Hong Kong SWIFT BIC Code: CITI HK HX For further credit to: [Insert All Account Holder Name(s)] If funds wired in Japanese Yen: Citibank Japan (Ltd.) Honten Branch Citigroup Center 2-3-14 Higashi Shinagawa Shinagawa-ku, Tokyo Japan zip-code: 140-8639 SWIFT BIC Code: CITI JP JT Interactive Brokers LLC Bank Account No. 0159170403 For further credit to: [Insert All Account Holder Name(s)] If funds wired in Mexican Peso: Banco Nacional de Mexico, S.A. Mexico Location: 3er Piso Torre Norte Act. Roberto Medellin No. 800 Col. Santa Fe, Mexico, D.F. 01210 Tampa Location: Citigroup Global Transaction Services 3800 Citigroup Center Tampa FL SWIFT BIC Code: CITIUS33MER * Interactive Brokers LLC Bank Account No. at Banamex: 231440011** For further credit to: [Insert All Account Holder Name(s)] If funds wired in Swedish Crona: Skandinaviska Enskilda Banken AB SKANDINAVSKA ENSKILDA BANKEN KUNGSTRÄDGÅRDSGATAN 8 106 40 STOCKHOLM SWIFT BIC Code: ESSESESS Interactive Brokers LLC Bank Account No. at S-E Banken: SE8850000000055558500891 For further credit to: [Insert All Account Holder Name(s)] If funds wired in New Zealand Dollars: Citibank, N.A. (Auckland) 23 Customs Street East Level II, Citibank Centre, Auckland, New Zealand NZ Bank Code: 312840 SWIFT BIC Code: CITINZ2X Interactive Brokers LLC Bank Account No.: 312840003254901 For further credit to: [Insert All Account Holder Name(s)] Account Transfer from Another Brokerage Firm (ACATS/ATON): Complete this section only if you want to initially fund your account through a transfer of assets and/or cash from a U.S. securities broker (ACATS) or a Canadian securities broker (ATON): Please note: The Account Name, Tax Identification Number, and Account Type (i.e. individual, joint, Roth IRA) for your Interactive Brokers account must exactly match the brokerage account from which you are transferring assets in order for the transfer to take place. Also, please note that Interactive Brokers accepts transfers only of assets that IB makes available for trading. Certain products, such as mutual funds and limited partnership units cannot be transferred to or held in your Interactive Brokers account. Name of brokerage firm that transfer is coming from Account number of account being transferred Type of account being transferred (individual, joint, IRA etc...) If transfer is from an IRA account, what type? (Roth, etc...) Do you have a margin loan in the account being transferred? Yes No Are there options positions in the account being transferred? Yes No Do you have any short positions in the account being transferred? Yes No Are you transferring all assets from the account or just some assets? Full Transfer Partial Transfer Instructions for Account Transfer from Another Broker: Customer requests that transferring broker transfer to Interactive Brokers the specified assets in the third-party brokerage account specified above. Customer understands that to the extent any assets are not readily transferable, with or without penalties; such assets may not be transferred within the time frames required by the NYSE Rule 412 or similar rule of NASD or other designated examining body. Unless otherwise indicated, customer authorizes the transferring broker to liquidate any non-transferable proprietary money market fund assets that are part of the account and to transfer the resulting credit balance to Interactive Brokers. Customer authorizes transferring broker to deduct any outstanding fees due from the credit balance in the account. If the account does not contain a credit balance, or if the credit balance is insufficient to satisfy any outstanding fees due, Customer authorizes transferring broker to liquidate the assets in the account necessary to satisfy any obligation. Full Transfer: If you are transferring ALL the assets from another brokerage account into your Interactive Brokers account (full transfer), you do not need to complete the form below. Partial Transfer: If you are transferring only SOME of the assets from another brokerage account into your Interactive Brokers account (partial transfer), you must list all: 1) stock; 2) options; and 3) cash that you want to transfer. Use the form below and attach additional pages if necessary. Partial Account Transfer Form (use only if you are opening your account by transferring only part of an account with another brokerage firm to Interactive Brokers). Use the lines below and attach additional pages if necessary: Positions: Stocks: Page 28 / 40
Symbol Number Shares Long/Short Long Short Long Short Long Short Long Short Long Short Options (Please note, this is not available for ATON Underlying Symbol Number of Contracts Strike Price Expiration (yyyy/ mm/dd) Put/Call Long/Short Put Call Long Short Put Call Long Short Put Call Long Short Put Call Long Short Put Call Long Short Cash - ACATS are available for USD accounts only. ATONs are available for USD and CAD accounts Amount Positive Cash Balance or Margin Loan? Cash balance Margin Loan If your broker requires a paper ACAT signature form for transfer, you must send a signed copy of the ACAT portion of your application to your broker. Signature of Account Holder Signature of Joint Account Holder Date Date Page 29 / 40
VII. NECESSARY ACCOUNT DOCUMENTATION Regulations require Interactive Brokers to obtain documentation verifying the identity of each of its customers. Please make sure all documents are clear and readable.please see further instructions below: Document Category Acceptable Documents (only one document per category is needed) Proof of client's identity and date of birth (The document must include client's name, date of birth, photograph and signature) Proof of client's address (The document must clearly state client's residential address) Passport Driver's License Mortgage Statement, Deed or Other Evidence of Property; Current Lease; Utility Bill (less than 12 months old); Current Driver's License But if you used driver's license as proof of identity, then we are required to obtain a second, different document for proof of address (i.e., driver's license cannot be used again); Bank Statement, Bank-Issued Credit Card Statement or Bank- Issued Debit Card Statement or Signed Letter from Bank on Bank Letterhead Confirming Address Customer and bank must be from a country that is a member of the Financial Action Task Force on Money Laundering (see http://www.fatf-gafi.org); Statement must be less than 12 months old; Brokerage Statement from a U.S.-Registered Broker Dealer or Foreign Affiliate of a U.S.-Registered Broker Dealer Customer must be from a country that is a member of the Financial Action Task Force on Money Laundering (see http://www.fatf-gafi.org); Statement must be less than 12 months old; Current Homeowner's or Renter's Policy Documents or Riders Policy must be currently in effect; Bill for Homeowner's or Renter's Insurance Policy (less than 12 months old); Security System Bill/Statement (less than 12 months old); or Government-Issued Letters or Statements Establishing Current Address (less than 12 months old). E.g: Tax Letters and notices; Letters or notices from government housing authorities; Jury duty notices; Voter registration notices; Other official government letters or notices showing customer name and address being verified. Page 30 / 40
VIII. RETURN YOUR COMPLETED APPLICATION (ALONG WITH REQUIRED DOCUMENTS) TO YOUR ADVISOR OR TO INTERACTIVE BROKERS Please complete all information required in this application, provide all required signatures, and return the entire application to your Financial Advisor or directly to Interactive Brokers. Please make sure to include copies of all required documents listed above, as well as a check (if you are opening your account with a check). If your advisor has instructed you to send your application directly to Interactive Brokers, you may use any of the methods below: Scan and Email (This is the fastest method) newaccounts@interactivebrokers.com Please note: The scanning and emailing option is typically the most efficient method, and will make account review quicker. Please be aware of the following guidelines and limitations when sending us e-mails or scanned document attachments. Please send emails as text rather than HTML format. If possible, users of Microsoft Outlook emailer should disable RFT (rich-text format) encoding. Only the following attachment types are accepted:.gif.tiff.tif.jpeg.jpg.png.bmp.pdf. Please limit the size attachment to 10MB. Please limit the size of e-mail text to 2,000 characters. Emails longer than that will be truncated. When sending a document by email, please only include your account number in the Subject line of your email. This will allow the Interactive Brokers system to automatically post your email (with any attachments) to your application. Courier/Overnight Service (e.g. Fed Ex) Mailing your documentation via overnight carrier is also a choice, but please keep in mind that the processing time for approval of the account may take longer than if sending by email or fax. Interactive Brokers LLC Document Processing 209 South LaSalle Street, 10th Floor Chicago, IL 60604 Fax (312) 984-1017 Please note: Scanning and emailing required documents or sending documents by Courier/Overnight service are the best methods of sending documents. If you prefer to send documents via fax, please observe the following guidelines: Please enlarge documents to at least 125% of the normal size (up to 3/4 page-size) so we can read the document. Please lighten the documents by one or two increments when copying or faxing. As a general rule, before faxing, please make sure that all text is large and clear, and legible. Mail Mailing your documentation through the regular postal service is also a choice, but please keep in mind that the processing time for approval of the account may take longer than if sending by email or fax. Interactive Brokers LLC Document Processing 209 South LaSalle Street, 10th Floor Chicago, IL 60604 Should you have any questions, please send us an email addressed to newaccounts@interactivebrokers.com or call: 1-877-4IB-BRKR (877-442-2757) or +1-312-542-6901. Page 31 / 40
Form W-9 (Rev. October 2007) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Request for Taxpayer Identification Number and Certification Give form to the requester. Do not send to the IRS. Business Name, if different from above Check appropriate box: Individual/Sole Corporation Partnership Proprietor Limited liability company. Enter the tax classification: Disregarded entity Corporation Partnership Other (see instructions) Exempt Payee Address (number, street, and apt. or suite no.) Requester's name and address (optional) City, state, and Zip/Postal code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident or alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is Employer identification number your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Certification Under penalties of perjury, I certify that: The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person Date (MM-DD-YYYY) Form W-9 (Rev. 10-2007) Page 32 / 40
Form W-8BEN (Rev. February 2006) Department of the Treasury Internal Revenue Service Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding» Section References are to the Internal Revenue Code.» See separate instructions.» Give this form to the withholding agent or payer. Do not send to the IRS. OMB No. 1545-1621 Do not use this form for: Instead, use Form: A U.S. citizen or other U.S. person, including a resident alien individual......w-9 A person claiming that income is effectively connected with the conduct of a trade or business in the United States......W-8ECI A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)......w-8eci or W-8IMY A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization,foreign private foundation, or government of a U.S. possession that received effectively connected income or that isclaiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions)......w-8eci or W-8EXP Note: These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only to claim they are a foreign person exempt from backup withholding. A person acting as an intermediary......w-8imy Note: See instructions for additional exceptions. Part I Identification of Beneficial Owner (See instructions.) 1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization 3 Type of beneficial owner: Individual Corporation Disregarded entity Partnership Simple trust Grantor trust Complex trust Estate Government International organization Central bank of issue Tax-exempt organization Private foundation 4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 5 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 6 U.S. taxpayer identification number, if required (see instructions) SSN or ITI 7 Foreign tax identifying number, if any (optional) EIN 8 Reference number(s) (see instructions) Part II Claim of Tax Treaty Benefits (if applicable) 9 I certify that (check all that apply): a The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. b c d e If required, the U.S. taxpayer identification number is stated on line 6 (see instructions). The beneficial owner is not an individual, derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the requirements of the treaty provision dealing with limitation on benefits (see instructions). The beneficial owner is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign corporation, and meets qualified resident status (see instructions). The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file Form 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000. Page 33 / 40
10Special rates and conditions (if applicable see instructions): The beneficial owner is claiming the provisions of Article of the treaty identified on line 9a above to claim a % rate of withholding on (specify type of income):. Explain the reasons the beneficial owner meets the terms of the treaty article: Part III Claim of Tax Treaty Benefits (if applicable) 11 I have provided or will provide a statement that identifies those notional principal contracts from which the income is not effectively connected with the conduct of a trade or business in the United States. I agree to update this statement as required. Part IV Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates, The beneficial owner is not a U.S. person, The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject to tax under an income tax treaty, or (c) the partner's share of a partnership's effectively connected income, and For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Capacity in which acting For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 2-2006) Page 34 / 40
Form W-8ECI (Rev. December 2000) Department of the Treasury Internal Revenue Service Certificate of Foreign Person s Claim for Exemption From Withholding on Income Effectively Connected With the Conduct of a Trade or Business in the United States» Section References are to the Internal Revenue Code.» See separate instructions.» Give this form to the withholding agent or payer. Do not send to the IRS. OMB No. 1545-1621 Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business (see instructions). Do not use this form for: Instead, use Form: beneficial owner solely claiming foreign status or treaty...w-8ben benefits... A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443 (b)......w-8exp Note: These entities should use Form W-8ECI if they received effectively connected income (e.g., income from commercial activities). A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States)......W-8BEN or W-8IMY A person acting as an intermediary......w-8imy Note: See instructions for additional exceptions. Part I Identification of Beneficial Owner (See instructions.) 1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization 3 Type of beneficial owner: Partnership Individual Corporation Disregarded entity Government Simple trust or grantor trust Complex trust Estate Private foundation International organization Central bank of issue Tax-exempt organization 4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 5 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 6 U.S. taxpayer identification number, if required (see instructions) SS or ITI EIN 7 Foreign tax identifying number, if any (optional) 8 Reference number(s) (see instructions) 9 Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or business in the United States Part II Certification Page 35 / 40
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: I am the beneficial owner (or I am authorized to sign for the beneficial owner) of all the income to which this form relates, The amounts for which this certification is provided are effectively connected with the conduct of a trade or business in the United States Sign and are includible in my gross income (or the beneficial owner s gross income) for the taxable year, and The beneficial owner is not a U.S. person.. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Capacity in which acting For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25045D Form W-8ECI (Rev. 12-2000) Page 36 / 40
Form W-8EXP (Rev. December 2000) Department of the Treasury Internal Revenue Service Do not use this form for: Certificate of Foreign Government or Other Foreign Organization for United States Tax Withholding (For use by foreign governments, international organizations, foreign central banks of OMB No. 1545-1621 issue, foreign tax-exempt organizations, foreign private foundations, and governments of Department of the Treasury U.S. possessions.)» Seciton References are to the Internal Revenue Code.» See separate instructions.» Give this form to the withholding agent or payer. Do not send to the IRS. Any foreign government or other foreign organization that is not claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443 (b)... A beneficial owner solely claiming foreign status or treaty benefits... A foreign partnership or a foreign trust... A person claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States... OMB No. 1545-1621 Instead, use Form:...W-8BEN or W-8ECI...W-8BEN...W-8ECI or W-8IMY...W-8ECI A person acting as an intermediary......w-8imy Part I Identification of Beneficial Owner (See instructions.) 1 Name of organization 2 Country of incorporation or organization 3 Type of Foreign government International Foreign central bank of issue not Foreign tax-exempt organization organization wholly owned by the foreign sovereign) entity Government of a U.S. possession Foreign private foundation 4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 5 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 6 U.S. taxpayer identification number, if required (see instructions) 7 Foreign tax identifying number, if any SS or ITI EIN (optional) 8 Reference number(s) (see instructions) Part II Qualification Statement 9 For a foreign government: a I certify that the entity identified in Part I is a foreign government within the meaning of section 892 and the payments are within the scope of the exemption granted by section 892. Check box 9b or box 9c, whichever applies: b The entity identified in Part I is an integral part of the government of c The entity identified in Part I is a controlled entity of the government of 10 For an international organization: I certify that: The entity identified in Part I is an international organization within the meaning of section 7701(a)(18) and The payments are within the scope of the exemption granted by section 892. Page 37 / 40
11 For a foreign central bank of issue (not wholly owned by the foreign sovereign): I certify that: The entity identified in Part I is a foreign central bank of issue, The entity identified in Part I does not hold obligations or bank deposits to which this form relates for use in connection with the conduct of a commercial banking function or other commercial activity, and The payments are within the scope of the exemption granted by section 895. 12For a foreign tax-exempt organization, including foreign private foundations: If any of the income to which this certification relates constitutes income includible under section 512 in computing the entity s unrelated business taxable income, attach a statement identifying the amounts. Check either box 12a or box 12b: a I certify that the entity identified in Part I has been issued a determination letter by the IRS dated that is currently in effect and that concludes that it is an exempt organization described in section 501(c). b I have attached to this form an opinion from U.S. counsel concluding that the entity identified in Part I is described insection 501(c). For section 501(c)(3) organizations only, check either box 12c or box 12d: c If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that the organization is not a private foundation described in section 509. I have attached an affidavit of the organization setting forth sufficient facts for the IRS to determine that the organization is not a private foundation because it meets one of the exceptions described in section 509(a)(1), (2), (3), or (4). d If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that the organization is a private foundation described in section 509. For a government of a U.S. possession: I certify that the entity identified in Part I is a government of a possession of the United States, or is a political subdivision thereof, and is claiming the exemption granted by section 115(2). Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that: The organization for which I am signing is the beneficial owner of the income to which this form relates, The beneficial owner is not a U.S. person, For a beneficial owner that is a controlled entity of a foreign sovereign (other than a central bank of issue wholly owned by a foreign sovereign), the beneficial owner is not engaged in commercial activities within or outside the United States, and For a beneficial owner that is a central bank of issue wholly owned by a foreign sovereign, the beneficial owner is not engaged in commercial activities within the United States. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Capacity in which acting For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25401F Form W-8EXP (Rev. 12-2000) Page 38 / 40
Form W-8IMY (Rev. December 2003) Department of the Treasury Internal Revenue Service Do not use this form for: Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding» Seciton References are to the Internal Revenue Code.» See separate instructions.» Give this form to the withholding agent or payer. Do not send to the IRS. A beneficial owner solely claiming foreign status or treaty benefits... A hybrid entity claiming treaty benefits on its own behalf... A person claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States... A disregarded entity. Instead, the single foreign owner should use... A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443 (b)... Part I Identification of Entity OMB No. 1545-1621 Instead, use Form:...W-8BEN...W-8BEN...W-8ECI...W-8BEN or W-8ECI...W-8EXP 1 Name of individual or organization that is acting as intermediary 2 Country of incorporation or organization 3 Type of entity check the appropriate box: Qualified intermediary. Complete Part II. Withholding foreign trust. Complete Part V. Nonqualified intermediary. Complete Part III. Nonwithholding foreign partnership. Complete Part VI. U.S. branch. Complete Part IV. Nonwithholding foreign simple trust. Complete Part VI. Withholding foreign partnership. Complete Part V. Nonwithholding foreign grantor trust. Complete Part VI. 4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 5 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country (do not abbreviate) 6 U.S. taxpayer identification number, if required (see instructions) SS or ITI EIN QI-EIN 7 Foreign tax identifying number, if any (optional) 8 Reference number(s) (see instructions) Part II Qualification Intermediary 9a (All qualified intermediaries check here) I certify that the entity identified in Part I: Is a qualified intermediary and is not acting for its own account with respect to the account(s) identified on line 8 or in a withholding statement associated with this form and Has provided or will provide a withholding statement, as required. b (If applicable) I certify that the entity identified in Part I has assumed primary withholding responsibility under Chapter 3 of the Code with respect to the account(s) identified on this line 9b or in a withholding statement associated with this form c (If applicable) I certify that the entity identified in Part I has assumed primary Form 1099 reporting and backup withholding responsibility as authorized in its withholding agreement with the IRS with respect to the account(s) identified on this line 9c or in a Page 39 / 40
withholding statement associated with this form Part III 10a b Part IV Nonqualified Intermediary (All nonqualified intermediaries check here) I certify that the entity identified in Part I is not a qualified intermediary and is not acting for its own account. (If applicable) I certify that the entity identified in Part I is using this form to transmit withholding certificates and/or other documentary evidence and has provided or will provide a withholding statement, as required. Certain United States Branches Note: You may use this Part if the entity identified in Part I is a U.S. branch of a foreign bank or insurance company and is subject to certain regulatory requirements (see instructions). 11 I certify that the entity identified in Part I is a U.S. branch and that the payments are not effectively connected with the conduct of a trade or business in the United States. Check box 12 or box 13, whichever applies: 12 I certify that the entity identified in Part I is using this form as evidence of its agreement with the withholding agent to be treated as a U.S. person with respect to any payments associated with this certificate. 13 I certify that the entity identified in Part I: Part V Is using this form to transmit withholding certificates or other documentary evidence for the persons for whom the branch receives a payment and Has provided or will provide a withholding statement, as required. Withholding Foreign Partnership or Withholding Foreign Trust 14 I certify that the entity identified in Part I: Part VI Is a withholding foreign partnership or a withhholding foreign trust and Has provided or will provide a withholding statement, as required. Nonwithholding Foreign Partnership or Withholding Foreign Trust 15 I certify that the entity identified in Part I: Part VII Is a nonwithholding foreign partnership, a nonwithholding foreign simple trust, or a nonwithholding foreign grantor trust and that the payments to which this certificate relates are not effectively connected, or are not treated as effectively connected, with the conduct of a trade or business in the United States and Is using this form to transmit withholding certificates and/or other documentary evidence and has provided or will provide a withholding statement, as required. Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income for which I am providing this form or any withholding agent that can disburse or make payments of the income for which I am providing this form. Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25402Q Form W-8IMY (Rev. 12-2003) Page 40 / 40